Axiom Home Page Forums General Discussion The Water Cooler It's all in your head

This is my longest post ever. I apologize.

This is about my experience. It is not for me, nor is it for my amusement. It’s for you, each of you. It is the real New Year's wish I would make for everyone.

If it twangs only one tuning fork out there that ain’t hittin’ A440, then I hope it’s worth reading.

Last month I read a piece on depression that pissed me off. “A recent study revealed” (there’s one for Ray’s snap-lid dumpster) that women are almost twice as likely to be taking anti-depressants. The entire piece revolved around one question: “Why is this happening to women?”

Many avenues were explored—consequences of “liberation,” more work place demands, more single moms, more extra-curricular demands on their kids, blah, blah…

The question, “Who is more likely to seek help?” was posed. That answer was quick and simple; women, because they have more stresses. The pendant to the main question should have been, “Why isn’t this happening to men?” Right, it’s not happening to men. BS! I’ve taken you down the “men don’t take adequate care of their medical or psychological health” road before. We’re veering off right here.

Having logged far more couch hours than Tony Soprano could have afforded, let alone had the time for, I’ve been fairly confident that I have developed at least some tools to stay on top of my feelings. I got pretty good at clearly seeing what was, for me, that dreaded 4th day. If I had two of those “4th days” in less than 4-6 weeks, I was making an appointment before that second “4th day” was over. Sometimes I was very aware of the issue or issues that may have been involved, sometimes not at all. I only knew that I felt (pick as few or as many that apply, or create your own psych-sundae) listless, unhappy, trapped, occasionally hopeless, anxious, unsettled, disaffected, uninterested in what I usually wanted to do, or worse, uninterested in what I always had to do, etc. Hate to disappoint, but not even remotely suicidal, ever, no alcohol-infused self pity…really, never THAT low. I just knew I could plainly remember feeling “better,” but not "then." It's amazing how quickly recalling "felt better" becomes an entirely foggy proposition.

To avoid any confusion, I have never been diagnosed with a psychosis or anything that qualified as a disorder. These bouts, of which I may be free for years at a time…years…, slowed me down, but never stopped me, nor did they result in any significant compromise of function in any part of my life. Like most people’s, they were minor. I’d had therapy only, no meds until the last 9 years, and since then, only a very wimpy one at a very low dose. Over 32 years, I’ve never done therapy for longer than two years (26 weeks a year). Times between “the need” have ranged from 2 to 12 years. My “need” invariably revolves around being pushed off my little wall by surprise and by forces beyond my control, big forces. I’m good unless the fall involves serious head trauma.

Backstory over. The point.

What I’ve just described are some feelings everyone has from time to time. In the worst of times, they present themselves as extremes; times of desperation we all experience for ourselves our or loved ones--- serious illness, injury, death, career/financial disaster, failing parents. Or maybe it’s just that you’re out of meth for the 3rd time in as many days. Everyone’s got their reasons.

Friday morning I had the first appt. with my psych provider in almost 2 years. I’ve just told you that I feel pretty experienced at knowing when it’s time to dive in again. Well, Mr. Experience got blown out of the water with a new diagnosis (MDD) and new visits scheduled for the psychopharmacologist. And this is exactly my point! I have tons of experience with this, and, this time, I had no clue I was in for a Major Depressive Disorder diagnosis. No clue! Less than 20 minutes into it, the right questions from him and some honest answers from me, I realized I’ve been feeling this way for well over ½ a year, maybe a whole one. There is no defining instance, moment, event (doesn’t have to be and usually never is). Sometimes, you don’t see the little things piling up, until you can’t see over them.

Had you asked me on any average day in the past year how I was, I would have told you all was cool, and I would have (thought I) meant it. And I’m supposed to be Mr. I-Know-Myself-Smarty Pants (which are now dangling loosely at my psychological ankles.)

If, even in the deepest of your personal reflection, none of you sees any of yourself in here, that'd please me no end. Statistically, I have almost no belief that could actually be true, which is why I wrote this. However, deep beneath this crackly exterior hides the warm peanut butter filling of hope, which must remain closely guarded and kept under very strict control.

If I thought that revealing this would show any sign of weakness, I’d never have done it. It’s no sign of weakness to run to a doctor when you think your heart is unhappy, but I know you DO think that way when you feel like your brain is unhappy. So if you want to let yourself feel like that, do it. But if you think that any leak in your psychship is getting only your feet cold and wet, think again.

We all want to be thought of for who we are, not what we are. The “WHO you are” is in your f’head! If it ain’t workin’ like it’s s’pposed ta up there, you’re not being a very good “you” now, are ya?

I hope JP forgives me for slobbering all over his turf. This isn’t his job. He’s a healer, not a preacher. He really couldn’t do this without it coming off preachy. JP knows I'm kidding when I take swipes at him, because he knows how much I respect what he does and what it took for him to get there, even if he is an asshole. (Though currently of a far lesser order than I, ya gotta admit, he has "the gift.") If one of us on the boards were a dietician, we really wouldn’t like it if he/she were constantly reminding us of what we shouldn’t be eating (bacon thread endgame). But if one of us had dietary problems and found a way to feel better, I’m hoping we’d think it easier to hear it from him/her.

In BobWorld, there would be psych drive-thru’s hidden behind the dumpster fences at every McDonald’s, for quickies. If not, there should be one of Julius’ colleagues in every street corner office building, walk-ins welcome, for sliding scale-------------------- and they would drive Fiats and just GTF over it.

Again, perspective. Having done it both ways, it's far better to have a big depression, not caused by a concurrent minor illness, than to have a small depression, directly caused by a fatal one. Piece o' cake, this!

It's the only medical care (It's medical care, dillweeds! Whydya think they made JP go to MED school?) where you can directly affect how you recover (feel better), how well, and how quickly.
You have a hand in your own oxymoronic Happy Ending.

BTW, the BP has diminished by almost %60 in just 7 days. It was such a waste. I never really needed it to scare anyone.

Good post, Bob, and thank you.

One of my co-workers recently came back from a three month leave of absence to "right" himself. As tough as us guys think we are and putting on a brave face is all that's needed to get through, we do ourselves a disservice by ignoring obvious signs of needing help.

Sorry to hear you're feeling down in the Vatican dumpster (sic) Bob. Been there and to say its no fun is a ginormous understatement.

Amen, brother. And thanks.

Thanks for that post, Bob. Maybe one day I'll finally get my ass in to a shrink. It all sounds very familiar to me.

Sometimes reading Wikipedia can be entertaining.

"In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant."

That splains why you were logging on as god for a while.

Good post, and I certainly see pieces of myself in there.

Thanks for taking the time to read it, guys.

Sean, I hope you don't mind, but I'd like to refer to a couple of terms used in your repsonse that illustrate my point. It's not your personal choice of words. I think they're the most common ones called upon.

While even an aware and sensitive person might use the phrase "need(s) help," the stigma has already kicked in. When one goes to receive medical care, one doesn't refer to it as "getting help." It's a mentality that some part of one's body, that can be seen and felt, is broken, but not necessarily by one's own actions and therefore, not one's own fault.

The perception with mental health, is that the whole person is broken, when in most cases, there is no break at all, even in the parts. They may just not be working together as well as they should be. So, I'm not really refering to the people who suffer the horrific misfortune of psychotic breaks and serious psychoses. Rather, I'm refering to the entire rest of us who sometimes (inebitowawy) get kicked in the head by a horse we don't own, nor have ever seen. Simple word: life.

And just like with your body, you want to get even the tiniest of the bad stuff excised before it becomes malignant. It's like ignoring the monthly periodicals, even with good reason, then one day, you look at the coffee table and there are 30!

My big point is that this was all much smaller stuff that I ignored, avoided, was too dumb (distracted) to notice, knew was lurking and put off, thought about and dismissed, etc., etc. Not the stuff of psychopaths, the stuff that makes us all "normal." It's bad timing and large doses that push normal experience into overwhelming experience.

I haven't been paying attention (to lots of things) and it not only caught up with me, but took me by complete surprise. Now I have to devote more work/time/effort on the entire ball of puke than I would have had I been more, well, lots of things.

Could I get through this without therapy or a change in meds? Been through far worse with no assistance, no meds, so, "Yes." Do I want it to take that long, stay an interference for even one day more than necessary and still have new things cropping up before I've cleaned up this schmutz? No!

You don't have to have huge problems, you don't have to go for months and months or even weeks and weeks---and you do not have to end up with a perscription. The choices are all yours. How often do you get that? It can be revelatory, earthshaking, calming, redemptive. It is better than anything else you can possibly do for yourself, and more importantly, everyone who isn't you.

Which, of course, brings us back around to me. Like your family, friends and coworkers, I'm not you! You really effen piss me off, 'cause you need help and I can't deal with your nonsense anymore, you basket case.

I didn't think I was having unpleasant hallucinations when I was GOD. I had hoped I was causing them.

We need to dance around to old tv theme songs more.

Do you ever feel that being an artist makes you hurt a little more or is that just a stereotype?

Thanks, Fred. And I know you've been there, though you are getting closer to the end of owning that time-share in Crazylahara, I hope. Once again, though, I really don't feel that bad. That's why I was so surprised to "find out" that I "should." And not because I was told I should. My own answers to the questions did it. By only #4, it was, "OMFG! Absolutley! And how'd I let ALL of that get by me? I'm supposed to be a pro." My rug's been hiding so much dirt, that it looks like John Popper crawled under it to die.

I was picked on as a kid so my parents sent me to see a counselor over a couple years time. I really think it did me a lot of good in my latter years. Not saying I don't have the occasional bad day but I'm usually pretty steady and can deal with just about any situation without it bothering me much.

While you are correct about the phrase 'needs help' its actually a sign of a deeper western problem in that we see ourselves as completely independent entities when in fact we are not. It's even worse here in North America where we have wrapped ourselves in a myth that 'our' pioneer forefathers were completely self reliant when the complete opposite is true: pioneers were much more reliant on their community than we are today.

When you and I break an arm, we do indeed 'need help'. I have no clue how to set a bone properly. Yet somehow we have come to the strange conclusion that going to the doctor is not getting help.




I agree with you on the first point, but not the second. When some part of the mind starts functioning 'out of spec' something is broken even if we can't see it.

We are finally able to measure the electrical manifestations of depression to see that parts of the brain are no longer functioning properly. Call it a sprain if you don't like the term broken, but something is clearly no longer working properly.

Point is, depression is much like other things that afflict us complete with physical (albeit not so obvious) manifestations.


Hey, shit happens. Sometimes we catch it, sometimes we don't. Hindsight has to be the most useless human 'skill' there is.

OK, the pedant in me is done for tonight.

Dude, get your shit together. MDD = Major Depressive Disorder. How can you be majorly depressed if you're not feeling that bad?

I've got a question for you Netflix guys. Can we send Bob a movie to cheer him up? I was thinking One Flew Over The Cuckoo's nest.

Summed up in one word. Denial.

From my experience, the people that need this type of "help" the most are the ones that don't think they need it the most. I have a brother and a sister that are text book examples of that. Myself, I've gone through more "theropy" than I care to mention. But, hey. It's help cleared up a lot of my bad thinking patterns.

There it is, Fred! That's why I wrote it. I don't feel very bummed out. I made the appointment a couple of weeks ago, because of only one issue that I wanted help sorting out. I wasn't at all fixated on it, yet I was unaware there was so much more lurking. All of my experience with this stuff wasn't telling me what I needed to know, or do.

So if I can be clinically depressed and not know it, then there are too many people who could be way happier than they are aware is possible.

If one person read it and thought to himself, "That's something I should consider doing for myself this year," I'd be thrilled for them.

Every year your GP does standard tests to make sure nothing is wrong on the inside. No one gets a yearly screening to make sure about the inside.

Senator Eagleton had to bow out of a VP nomination with Ford, when it was revealed he had been to a psychiatrist. If he had had a heart condition, no one would have flinched. It was long time ago, but the perception persists. Even then I thought that voters should insist that every candidate sees a shrink before he can declare.

Of all the artists, musicians and writers I have known, I can think of only a couple who have not sought therapy. When you spend most of your time alone in your own head, you keep dragging more and more crap up there (brain hoarding). It gets so crowded that there isn't room for anything or anyone else and that's when the other components of your life start heading down the crapper. The level of success attained has no correlation to the dysfunction, from my point of view, especially when you add substance abuses to some of their lists.

So many were smart enough no to reproduce and drag a family through the uncertainties of a career in the arts. It's the ones who weren't that I feel badly for.

Personally I think it appears to happen more to women because most guys just don't care nor notice when things are wrong, myself included. My wife had/has boughts of depression and she watches me like a hawk for signs of depression, she knows when things are not quite right with me and I never notice a difference.

Hey, Bob, et al.

I saw your post on the weekend but waited until this AM to reply because composing a long reply on an iPhone, with links, would have been painful.

No worries at all about stepping on my toes or turf. You did not do that, of course, because I have no exclusive claim to psychiatric topics here or anywhere.

Let me add my kudos for your post. You spoke from the heart about very personal issues and tied them to societal health concerns and a concern for your fellow Axiomites. Your encouragement may indeed help others get healthier.

I think that you are on the money about male depression. It is often missed, both by the person suffering from it and from the health providers that he sees. The potential reasons for this include societal (and inner) pressure to just “suck it up/get a grip”, the general stigma of having a psychiatric condition or seeing a psychiatrist, the gender-specific stigma of having depression as a man, and the ways that depression can present differently in men.

There’s lots of good books out there on masculine depression. One is The Pain Behind the Mask: Overcoming Masculine Depression. The authors identify two defining characteristics of masculine depression: dissociating from feelings and acting out suppressed feelings in destructive behaviors.

If a man is not in touch with his feelings because he is consciously or unconsciously pushing them aside – due to their unpleasantness – then it is not surprising that a lot of depressed men, including Bob, will not think of themselves as sad or depressed. I think that situations like this help explain why the diagnostic criteria for Major Depressive Disorder do not actually require a person to identify his mood as sad. The diagnosis is made when a person has five of nine criteria, one of which must include either sadness or anhedonia, which is a significant decline in interest of pleasurable activities. You know, when you just don’t feel like doing the things that you used to do for fun. The bottom line is that the cluster of symptoms leads to a significant decline in functioning lasting at least two weeks (and is not explained by substance abuse – because then the diagnosis changes – or by another psychiatric condition which would take precedent, like bipolar disorder, or by bereavement, which is a separate issue).

The other defining characteristic, according to Lynch and Kilmartin, also helps explain why depression is often missed in men. Rather than appear sad, a man will appear angry. He’ll get irritable, and people will think he’s just a jerk. Or he’ll hit the bottle, and he’ll be identified as an alcoholic, when really, the roots of the alcoholism were in a depression. Or he’ll hit his wife, and he’ll be diagnosed as bipolar, or just arrested and never diagnosed. Or he’ll wonder why he can’t stop cheating on his partners and looking at porn. Sometimes there’s an emptiness inside that he’s trying to fill, not realizing that he’s depressed because he just doesn’t understand his true feelings.

I’ll stop sermonizing for now – but again, thanks for shedding light on an important subject, Bob.

Don't ever link porn and depression ever again! I thought I had a life threatening condition for a second .

Bob, I apologize for not posting when I read this thread. I knew that I could take an hour to write a very informed, compassionate response.

But I figured I'd wait till JP posted, then write: "Me Too".

Honestly, thanks for taking the time to write. I recognize some of that, and to a minor degree have dealt with some of the same issues.

It takes a confident man to say "Eff the stigmas, I'm posting this because it's the truth and I care about these people"!

Do what I do. Eat a lot.

Thanks everyone. Just glad that lots of you took the time to read it and think on it for a minute or two. And special thanks to THE clarifyer!

You're now aware that it is common and can be startlingly invisible to one's self, and those who know you well, too!

Stand way back from the mirror every now and then. If what you see ain't lookin' as chirpy as you've remembered, or would like, go get some happy. You deserve it way more than a new amp.

The reason why this is a powerful thread is because Bob took the time to tell his story.

Narrative brings power and understanding to our shared experiences.

So, thanks again, Bob. “The condition upon which God hath given liberty chirpiness to man is eternal vigilance” (John Philpot Curran, not Jefferson, btw)

Has it been long enough? Can we non sequitur the thread now?

Agreed, Sean.


Actually, sometimes I do. I tell my patients to get to their family doctor so he/she can help them get their diabetes under control, or their blood pressure, etc.

I had a professor in residency who put things in perspective when she said that we (psychiatrists) are here when friends, family, pastors, etc are unable to help. That's when it gets clinical, yo. Actually, the last sentence was me.

As you said, I didn't get any negative connotation from his post. Just sayin'.

Bob wrote:


JP wrote:


I knew it! Denial. Don't worry Bob, we'll help you come to see how bad you feel. Really.

Quite aside from the social stigma and resulting denial, depression is particularly nasty because it renders you unable to either accurately assess your condition or do something about it. Depression robs you of the clarity of mind to see what is happening and robs you of the ability to reach out for help.

ON A BRIGHTER NOTE:

I cannot believe that I didn't include this, prominently, somewhere in all that gush.

Though you guys are poor substitutes for most things of value, when it comes to therapists, psychopharms, psych meds and CBT (Cognitive Behavioral Therapy), you are, indeed, a pretty good oleo:

This place takes 24/7 "walk-ins," there's always some charlatan available to write a chuckle perscription, and I like that the side effects are so unpredictable.

I just wanted to say that before I discover that my MDD is your fault.

Impossible. The official party line remains: it's all your mother's fault.

Boy you just never know what you are going to come back to on this board after a vacation.

Bob, you should be commended for taking the time to bring this topic forward. Having spend many an hour in waiting rooms and visiting areas for family members and friends who have been through similar challenges, I can associate but mostly from the third person.

Epiphany. I just edited the above sentence to add the word mostly. You all just made me realize something that I myself may have been in denial about to some degree.

Quiet often the weight of depression in someone struggling with these symptoms can spread to the people closest around them. It could be in the form of sadness as you watch your friend or loved one struggle. It could be a burning frustration from the feeling of helplessness. It can often become a severe stress, maybe even a depression of it's own from feeling like you have to be the one to behave perfectly ALL THE TIME or 'walk on eggshells' all the time. The periods of silence because your afraid that everything you say will be misconstrued and result in the person crying, being upset or angry.

My point? Twofold I guess. I just wanted to add that if you ("you" being the figurative "anybody") think you can suck it up and handle your challenges on your own, consider that you might be effecting more than just yourself. Your friends/family will likely never tell you they are struggling to keep it together for you. If your lucky, they will still always be there for you but their suffering may be growing as well due to your denial. In the worst cases, I could see how if this ripple effect is left to stagnate on it's own, it could result in lost friendships and broken marriages.

Secondly, as loyal as the friend may be, their loved one's challenges may be bringing them to a place where it couldn't hurt to get some help themselves. (Sorry Bob, I couldn't think of another word here vs. "help" but I don't consider the word derogatory or demeaning at all when used in this context.) Just because you are trying to be the strong one, doesn't mean that you couldn't use some support in the process. Even the strongest platoon of relief soldiers needs reinforcements eventually.

Admittedly, I never practiced what I just preached but perhaps now I will be much more likely to do so.

Where was your vacation? Cozy cabin on the shores of the River Styx?

I don't know, but I'll bet CV has the postmark stamp from the underworld to prove it!

What? Oh, never mind.

Ha. No, just relaxed at home. I had vacation that I needed to get off the books before the end of the year. Ignored computers for the entire time though. Well, except for the HTPC but it doesn't count.